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Cancer Perspectives: The Expert Is In

Canadian Case Studies: Drug Waste – An Opportunity to Save Costs? How is Immigration Linked to Cancer Outcomes?

June 13, 2017

ASCO Perspective

“These studies highlight aspects of cancer care that have not been widely explored, but have important implications for improving care delivery and constraining cost for residents of Ontario.”

Richard L. Schilsky, FACP, FASCO, ASCO Chief Medical Officer

Last year, the expected number of new cancer diagnoses in Ontario topped more than 85,000. In addition, the number of diagnoses and incidence rate of cancer has increased every year in Ontario since 19811. Two new studies in the Journal of Oncology Practice (JOP) examine practices in Ontario, Canada, and provide insights into the delivery of care in the province. The first study explores the financial impact of drug wastage, and the second describes the impact of immigration status on cancer outcomes.

Cost Savings Achieved by Mitigating Drug Wastage

Drug wastage in cancer treatment occurs when a drug in a fixed vial is not fully administered to a patient. A new cross-sectional study of three University of Toronto affiliated hospitals over a two-week span found that their current strategies to prevent wastage resulted in significant cost savings. Without these strategies wastage would have cost 16-18% of the total drug costs at the hospitals. Over the three hospitals, the total drug cost ranged from $50,257 to $716,983. Without mitigation the projected cost of waste would have ranged from $11,232 to $149,131.

As drug pricing and hospital budgets continue to be a concern throughout North America, oncology care delivery centers are concerned with the impact of drug wastage. In Ontario, hospitals are only reimbursed by the public payer for the amount of the drug administered. The hospital takes on the cost of wasted drugs.

Important debates on the sterility of single dose vials and drug waste have effects beyond cost. The authors note that in the coming years, new sterile compounding standards are expected to halt the ability to apply the current drug wastage mitigation strategies in Canada. Findings from this study will serve as pilot data to examine the feasibility of mitigation strategies when new standards are developed and implemented.

A new study finds that immigrants in Ontario have a lower cancer-specific mortality than Canadian-born individuals. Researchers examined population data from 2011, which identified nearly 3.6 million immigrants living in Ontario – about 27 percent of the province’s population. Study authors state that this is likely the, “first study to identify a consistent link between Canadian immigration and reduced cancer mortality.”

A population-based cohort study examined data from the Ontario Cancer Registry, which includes individuals that immigrated to the region since 1985. While previous research has observed the health outcomes of vulnerable and minority populations, the impact of immigration status on cancer outcomes has yet to be explored comprehensively.

The authors found a so-called “healthy immigrant” effect, noting that Ontario immigrants have a lower risk of cancer-specific mortality than Canadian-born individuals. Lower risk of cancer-specific mortality was greater for those who had been in Canada for less than 10 years. However, this effect seems to decrease the longer the immigrant lives in Canada.

The authors note that this healthy immigrant advantage has been shown in several studies in Canada and the United States, but differences in country immigration laws may play a role. Many Canadian immigrants are admitted under family re-unification, which often includes the positive social benefits of family and caregivers during cancer as well Canada’s single-payer health system.